| NPI | 1487646139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7246) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY MD-38014) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY DMD-7246) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-08-26 |