| NPI | 1285608141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN 12133) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 6847) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 3361) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-03-11 |