| NPI | 1912063025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901013501) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30017878) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019018808) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2008-12-04 |