| NPI | 1639403033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.023650) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS037067) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.099912) | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2013-08-05 |