| NPI | 1184919250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN21407) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011644A) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2023-08-18 |