| NPI | 1205164704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D13005) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.023036) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2020-12-03 |