| NPI | 1093827610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 6468) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 6468) |
| 122300000X Dentist (Licence: KY 6468) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-06-25 |