| NPI | 1922412030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-94) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-024176) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2016-08-25 |