| NPI | 1306299037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11643) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11643) |
| 122300000X Dentist (Licence: CA 100399) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2021-11-08 |