| NPI | 1710061320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 6509903-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30022427) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-08-30 |