| NPI | 1245625425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 10042) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TN 10042) |
| 122300000X Dentist (Licence: TN 10042) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-07-18 |