| NPI | 1558360461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 30-016274) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-016274) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-02-25 |