| NPI | 1265751937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.027063) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056395) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD LL844) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2023-06-25 |