| NPI | 1508021783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.022598) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 14941) |
| Enumeration Date | 2008-07-27 |
| Last Update Date | 2024-12-26 |