NPI | 1164902664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 12406) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS041728) |
204E00000X Oral & Maxillofacial Surgery (Licence: PA ds041728) | |
Enumeration Date | 2018-08-15 |
Last Update Date | 2024-10-15 |