| NPI | 1558651554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9865) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9865) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 9855) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2018-03-17 |