| NPI | 1528625704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 38168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH RES.004085) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-06-08 |