| NPI | 1295239259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 10234) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10234) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-10-01 |