| NPI | 1932490307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30.0239911) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 11536) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30-023991) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2021-10-06 |