| 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 |