| NPI | 1457926461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026491) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026491) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.026491) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2022-11-22 |