| NPI | 1134408198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-023506) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023506) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 30-023506) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2023-03-17 |