| NPI | 1275554065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30018431) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35054653) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |