| NPI | 1770713869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-023031) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023031) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2025-04-14 |