| NPI | 1831234533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 18958) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 18958) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2021-04-07 |