| NPI | 1245244474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 3399) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 3399) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-01-10 |