| NPI | 1710428271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401417691) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH RES.003794) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2021-09-08 |