| NPI | 1861601346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-21191) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.021191) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-12-17 |