| NPI | 1104927243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS372-03) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3282-03) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2010-09-15 |