| NPI | 1225220502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30-024035) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 055349) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2014-04-08 |