| NPI | 1649320201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK 184) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 5720) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2016-01-05 |