| NPI | 1922299510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009650) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30 022635) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2017-04-09 |