| NPI | 1154852697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9952) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025303) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2023-02-14 |