| NPI | 1497045694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D009976) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OH RES.2744) |
| 1223P0700X Dentist, Prosthodontics (Licence: WI 6758) | |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2022-06-13 |