| NPI | 1245384551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30019479) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30-01-9749) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2025-05-08 |