| NPI | 1316396419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY O61371) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 3705) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: KY 10310) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-09-07 |