| NPI | 1174616171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.147724) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD38394) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 7998) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-04-07 |