| NPI | 1043434954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 8443) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8443) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2024-03-26 |