| NPI | 1659582757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 023603) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 8714) |
| 1223E0200X Dentist, Endodontics (Licence: AZ D 7911) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-03-03 |