| NPI | 1568486769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: MI KE011553) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI KE011553) |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MI KE011553) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |