| NPI | 1417031436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7465 Dental) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 34759) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 34759) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2012-07-12 |