| NPI | 1982672150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 5067/500) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: KY 5067) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-09-13 |