| NPI | 1902958069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN18906) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022572) |
| 122300000X Dentist (Licence: FL DN18906) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-05-14 |