| NPI | 1093945560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8471) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8471) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8471) | |
| Enumeration Date | 2009-07-19 |
| Last Update Date | 2017-06-12 |