| NPI | 1265921878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12013970A) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30.025947) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2024-08-21 |