| NPI | 1104982016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 6861) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: KY 6861) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36087) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 6861) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-06-24 |