| NPI | 1184117202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 064560) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025457) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-07-31 |