| NPI | 1861537805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3409-105) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30-02-0974) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-02-04 |