| NPI | 1942950910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: KY 8059) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-02-0436) |
| 122300000X Dentist (Licence: KY 8059) | |
| 1223P0700X Dentist, Prosthodontics (Licence: OH 30-02-0436) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2023-08-09 |