| NPI | 1083287098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.028436) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03440868) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-05-12 |