| NPI | 1124478003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 11680) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL12925) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 65221) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-07-11 |