| NPI | 1932259207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025311) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5037) |
| 122300000X Dentist (Licence: IN 12010015A) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2018-03-17 |