| NPI | 1831188077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30018374) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35067574S) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2020-01-28 |