| NPI | 1497378053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026114) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026114) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 30.026114) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-12-27 |