| NPI | 1528037413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.019063) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 8588) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.019063) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-04-01 |