| NPI | 1629393707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.024930) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.024930) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901020878) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2020-11-08 |