| NPI | 1447547633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: HI MD-19235) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: HI DT-2692) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2019-04-02 |