NPI | 1740493907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN27127) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 8349) |
1223P0300X Dentist, Periodontics (Licence: OH 30.023093) | |
Enumeration Date | 2007-05-07 |
Last Update Date | 2022-07-22 |