| NPI | 1245979319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026760) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10602) |
| 1223E0200X Dentist, Endodontics (Licence: KY 10602) | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2025-09-12 |