| NPI | 1497737811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 20494) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: OH 30.020494) |
| Enumeration Date | 2005-11-20 |
| Last Update Date | 2025-08-19 |