| NPI | 1669847463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.025548) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH RES.3654) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2019-09-05 |