| NPI | 1366738247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 71.000285) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020453) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-11-29 |