| NPI | 1417104571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 20376) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KY 673) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |