| NPI | 1215998851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-021139) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30-021139) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-09-11 |