| NPI | 1639250491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 20309) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN15897) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2008-02-28 |