| NPI | 1588778344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.131775) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 3962) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-08-17 |