| NPI | 1184721995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000007685) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 0000031540) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-12-02 |