| NPI | 1942681317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.24838) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH res3574) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2016-06-27 |