| NPI | 1124711031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00206180) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30027191) |
| 1223E0200X Dentist, Endodontics (Licence: OH 30027191) | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2026-07-31 |