| NPI | 1114413945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN123583) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30025467) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2024-08-21 |