| NPI | 1922454800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.24705) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.24705) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2018-08-08 |