| NPI | 1033677851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30.026051) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026051) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2020-03-06 |