| NPI | 1689653529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE00007124) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30-014276) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-08 |