| NPI | 1952569584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-022925) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019776) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2010-05-06 |