| NPI | 1477671915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 8533) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 21556) |
| 122300000X Dentist (Licence: WV 3700) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-08-15 |