| NPI | 1356334072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IN 12012036A) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NE 106) |
| 122300000X Dentist (Licence: MI 2901019526) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2013-10-31 |