| NPI | 1467430538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS5132) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN MS34149) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2010-07-28 |