| NPI | 1578628038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 3735) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.021920) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |