| NPI | 1558561712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.022621) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.098208) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2011-11-22 |