| NPI | 1346391851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30019633) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 604) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901015833) | |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2007-07-08 |