NPI | 1215433685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 73026) |
Additional Taxonomies | 122300000X Dentist (Licence: TN 11259) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-03 |
Last Update Date | 2024-12-22 |