| NPI | 1275536252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 1849-79) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MS 1849-79) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2026-07-14 |