| NPI | 1225231228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30-022500) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: SC 4667) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2010-10-05 |