| NPI | 1902232424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TN 11146) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023978) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2019-08-22 |