| NPI | 1649889304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.028360) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD LL929) |
| 1223G0001X Dentist, General Practice (Licence: KS 61685) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2026-04-11 |