| NPI | 1285758185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 16404) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 15359) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2007-07-08 |