Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21583 | OH |
NPI | 1013050913 |
---|---|
Provider Name | Gerard J Bruno |
First Address | Canton, OH 44718-2406 |
Second Address | Canton, OH 44718-2406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 28/07/2009 |