| NPI | 1457626806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 4420) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 40129) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS-09138) | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2020-08-07 |