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 |