| NPI | 1306801782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011603A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7978) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2012-10-19 |