| NPI | 1285807081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000009136) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000009136) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2012-06-01 |