| NPI | 1639724438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: LA P-198) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH P-198) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2024-02-07 |