| NPI | 1659652949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: KS 61060) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: OH RES. 3083) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2022-12-12 |