| NPI | 1174878417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OK 6913) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9501) |
| 122300000X Dentist (Licence: KY 9298) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 210) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9298) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OK 37911) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2023-01-04 |