| NPI | 1316904451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 6026) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 778) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OK 24020) | |
| 1223G0001X Dentist, General Practice (Licence: KY 8350) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2017-04-07 |