| NPI | 1396031043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000010673) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3829) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2020-02-03 |