| NPI | 1245218544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-017004) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-017004) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-06-10 |