| NPI | 1316326903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.027429) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32594) |
| 122300000X Dentist (Licence: MD 15839) | |
| 1223G0001X Dentist, General Practice (Licence: TX 32594) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2024-04-12 |