| NPI | 1992363907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 40912) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026166) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026166) | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-08-23 |