| NPI | 1699752758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30-01-2211) |
| Additional Taxonomies | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: OH 35-031770) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-07-08 |