| NPI | 1497044846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30.024926) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024926) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2019-05-06 |