| NPI | 1831136902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 3498) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 3498) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 3498) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 3498) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-08-05 |