| NPI | 1629444898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64579) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026047) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026047) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2023-11-01 |