| NPI | 1326036237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 36020) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-02-1661) |
| 1223P0300X Dentist, Periodontics (Licence: OH 30.021661) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-12-27 |