| NPI | 1578793006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 30-023250) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028088) |
| 1223G0001X Dentist, General Practice (Licence: OH 30-023250) | |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2019-01-07 |