| NPI | 1679541247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30-020030) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30-020030) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.020030) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2023-01-03 |