| NPI | 1235802315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.027811) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106710) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2025-09-24 |