| NPI | 1154697704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN20072) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30-022895) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2015-07-15 |