| NPI | 1740489038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.023403) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08501) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2015-03-26 |