| NPI | 1073775839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 6780) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6780) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MS T-2530) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS PRV-TP-111-09) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2016-11-30 |