| NPI | 1205290681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.024780) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024780) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2018-08-17 |