| NPI | 1205275153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OH 30.024886) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 30.024886) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2022-09-21 |