| NPI | 1336140862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 4255) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 4255) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2008-01-09 |