| NPI | 1316916463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 7275) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: KY 7275) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2021-09-21 |