| NPI | 1386081628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 9682) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 9682) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2018-06-16 |