| NPI | 1033369749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.023007) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD3903) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-04-03 |