| NPI | 1942595053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61281) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.023445) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2020-06-21 |