| NPI | 1851374573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OH 30.020892) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30020892) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2021-10-26 |