| NPI | 1033310263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OH 30-01-8732) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-01-8732) |
| 1223G0001X Dentist, General Practice (Licence: FL DN14090) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN14090) | |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2025-09-11 |