| NPI | 1235286238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 71000195) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019026687) |
| 122300000X Dentist (Licence: MI 2901017827) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-10 |