| NPI | 1205410594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ID 9481505) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 12074) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 12074) | |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2026-08-06 |