| NPI | 1184680324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AR 3209) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3209) |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AR 56) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-10-23 |