| NPI | 1205241668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 65354) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 65354) |
| 122300000X Dentist (Licence: OH RES3439) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2024-08-05 |