| NPI | 1619255197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: OH 30.023483) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023483) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2018-09-25 |