| NPI | 1154731156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 53900) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9444) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2020-09-18 |