| NPI | 1053756502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9854) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12012589A) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9854) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2018-06-21 |