| NPI | 1841784493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 30.027266) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031703) |
| 122300000X Dentist (Licence: MO 2018022438) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-05-06 |