| NPI | 1972866580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.023770) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30023770) |
| 1223E0200X Dentist, Endodontics (Licence: OH 30.023770) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-09-07 |