| NPI | 1740356534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.087935) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 20929) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.020929) | |
| 208600000X Surgery (Licence: OH 35.087935) | |
| Enumeration Date | 2006-11-26 |
| Last Update Date | 2018-02-26 |