| NPI | 1952397879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901011245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-01-5078) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2012-12-10 |