| NPI | 1083846133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MT 21339) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 35685) |
| 122300000X Dentist (Licence: ID D-4215) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-4215-OS) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2022-01-26 |