| NPI | 1952705485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.024359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 60411179) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2017-11-14 |