| NPI | 1053389965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30-021097) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-021097) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-021097) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-02-26 |