| NPI | 1629075510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.023127) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 045048) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS035287) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-02-01 |