| 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 | 2026-05-14 |