| NPI | 1720578669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025378) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.025378) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2022-09-12 |