| NPI | 1083787386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 6942) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 6942) |
| 122300000X Dentist (Licence: KY 6942) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2015-10-14 |