| NPI | 1407836331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30-01-8220) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00008884) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2016-06-07 |