| NPI | 1871756924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7976) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7976) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7976) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2011-03-09 |