| NPI | 1861772279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30.023546) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: OH 31.012011) |
| 122300000X Dentist (Licence: OH 30023546) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2021-02-03 |