| NPI | 1063180446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.027455) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 37759) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-07-02 |