| NPI | 1952506404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8499) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8499) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2015-10-14 |