| NPI | 1548241367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022198) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.022198) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2025-08-27 |