| NPI | 1386836427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN24799) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3428-07) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS-519-16) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2024-04-22 |