| NPI | 1184126096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30025316) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30025316) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30025316) | |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2018-03-07 |