| NPI | 1073247730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.027981) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044045) |
| 122300000X Dentist (Licence: OH 30.027981) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2025-07-10 |