| NPI | 1265962682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS-10041) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 254) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7798) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA GA-0184) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2024-03-26 |