NPI | 1295873479 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 8281) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30.024338) |
1223P0300X Dentist, Periodontics (Licence: IN 12013412A) | |
Enumeration Date | 2007-02-01 |
Last Update Date | 2021-12-12 |