| NPI | 1427582964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.026403) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11222) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-06-14 |