| NPI | 1902002421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 2600) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 347922-9922) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2009-02-25 |