| NPI | 1346379948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 5552) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5552) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2008-05-14 |