| NPI | 1235146101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 19061) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 5949) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 5949) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2011-01-16 |