| NPI | 1780729251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3123-105) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-020834) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-01-23 |