| NPI | 1700879095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 7486) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY MD-39508) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2017-06-12 |