| NPI | 1134283765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 4550 341) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 4550) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-05-14 |