| NPI | 1972815124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-023277) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 843) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2017-04-05 |