| NPI | 1992116560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026040) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10267) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2022-09-13 |