| NPI | 1437384666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.023325) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 71000219) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2022-10-18 |