| NPI | 1215288493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 00159) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 48035) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2012-09-27 |