| NPI | 1922293315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8556) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30020098) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2008-06-16 |