| NPI | 1417290701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2022006623) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH RES.3166) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2022-06-06 |