| NPI | 1275794547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 33179) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5678) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 33179) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2018-04-12 |