| NPI | 1326665522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 18022) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004208) |
| 1223E0200X Dentist, Endodontics (Licence: WV 4526) | |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2024-11-13 |