| NPI | 1336157296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: PA DS024180L) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: OH 30017827) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |