| NPI | 1386037570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: HI DT-2883) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: HI MD-22040) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2021-10-04 |