| NPI | 1114248655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3770) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032082) |
| 1223G0001X Dentist, General Practice (Licence: AR 3770) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-10-25 |