| NPI | 1508879008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30014785) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30014785) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-12-14 |