| NPI | 1275033854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 36099) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025807) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.025807) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2023-03-20 |