| NPI | 1043657364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-5107-OS) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID M-15171) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE60941667) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2022-03-01 |