| NPI | 1760521850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8703) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 43017) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-06-12 |