| NPI | 1225055940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-023190) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019042) |
| 122300000X Dentist (Licence: OH 30-023190) | |
| 122300000X Dentist (Licence: WV 3894) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WV 34) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-06-21 |