| NPI | 1891952040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1857173) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30022312) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.022312) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2024-05-13 |