| NPI | 1215992854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 4332) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 4332) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-09 |