| NPI | 1174616171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 7998) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD38394) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-09-26 |