| NPI | 1912981945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026788) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19026503) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-02-21 |