| NPI | 1821090226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7038) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7038) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7038) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2015-01-26 |