| NPI | 1215943022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: AZ D011300) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: OH 30021000) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-10-14 |