| NPI | 1700880275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-01-5247) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35-04-7600-S) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-09-11 |