| NPI | 1982855839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 7921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-022823) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2015-03-17 |