| NPI | 1346629516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.024454) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024454) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2018-08-25 |