| NPI | 1184199390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.027447) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 11100) |
| 122300000X Dentist (Licence: OH 30.027447) | |
| 122300000X Dentist (Licence: TX 34669) | |
| 1223E0200X Dentist, Endodontics (Licence: TX 34669) | |
| 1223E0200X Dentist, Endodontics (Licence: KY 11100) | |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2024-08-21 |