| NPI | 1124486055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30025003) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025003) |
| Enumeration Date | 2016-02-06 |
| Last Update Date | 2022-04-21 |