| NPI | 1831220599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30019475) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN11719) |
| 1223E0200X Dentist, Endodontics (Licence: GA DN010654) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-01-13 |