| NPI | 1073616850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: KY 6172) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 6172) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2013-06-21 |