| NPI | 1821668567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 30.026891) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 10671) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2024-10-17 |