| NPI | 1356101380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.028009) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-05-20 |