| NPI | 1104850817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: OH 30-022368) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022368) |
| 1223G0001X Dentist General Practice (Licence: OH 30-022368) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-04-07 |