| NPI | 1942895479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026476) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: OH 31014849) |
| Enumeration Date | 2021-03-06 |
| Last Update Date | 2024-01-12 |