| NPI | 1477668176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 9257) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901018080) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30.023382) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-03-11 |