| NPI | 1417328733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN015198) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.025000) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2022-08-09 |