| NPI | 1154310985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8191) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8181) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011030A) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2014-06-12 |