| NPI | 1629156005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 5584) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 5584) |
| 122300000X Dentist (Licence: KY 5584) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-10-14 |