NPI | 1003336249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN LDR180202) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 09397) |
Enumeration Date | 2017-06-20 |
Last Update Date | 2018-07-03 |