| NPI | 1689082646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.025702) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 103129) |
| 122300000X Dentist (Licence: OH 30.025702) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2022-03-21 |