| NPI | 1699093351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 010779) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025660) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 010779) | |
| 1223G0001X Dentist, General Practice (Licence: CT 010779) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2021-11-07 |