| NPI | 1518973478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 4939) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4939) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 4939) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2017-12-27 |