| NPI | 1366676603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8728) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8728) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 48554) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2017-01-19 |