| NPI | 1891769352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30024099) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019-025936) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-09-13 |