| NPI | 1265727150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 15533) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 6313) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS-09173) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2019-07-09 |