| NPI | 1942436761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023515) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN03044) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-01-11 |