| NPI | 1124450663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11183) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6444) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2025-06-11 |