| NPI | 1285815589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3478) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8114) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2018-11-08 |