| NPI | 1598104853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 10067031-9922) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.023962) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2016-11-10 |