| NPI | 1972041150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30025261) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025261) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2022-04-20 |