| NPI | 1275072159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN24713) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025262) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30025262) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2022-07-22 |