| NPI | 1114981420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 5350) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 5350) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 397) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-11-22 |