| NPI | 1821777194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN124394) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH RES.004626) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2026-10-02 |