| NPI | 1144452293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3506-09) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3506-09) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MS T-3050) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2016-08-09 |