| NPI | 1285804260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30.026686) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WV 4206) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2022-06-07 |