| NPI | 1952723686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH RES.3313) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30024164) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-04-21 |