| NPI | 1457607434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 30-023702) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023702) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2023-04-11 |