| NPI | 1841859535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30026175) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004082) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2022-07-21 |