| NPI | 1437291655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8142) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8142) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 44040) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-08-07 |