| NPI | 1639502396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.026809) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022535) |
| 122300000X Dentist (Licence: MA DL13207) | |
| 1223E0200X Dentist, Endodontics (Licence: TX 29417) | |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2023-05-18 |