| NPI | 1548512916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29626) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039318) |
| 1223E0200X Dentist, Endodontics (Licence: OH 30.026782) | |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2022-06-03 |