| 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 |