| NPI | 1326465824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA CA64852) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025706) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH 30.025706) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: OH 30.25706) | |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2020-10-01 |