| NPI | 1487829420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AR 3396) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN18572) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IL 019.026579) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AR 3396) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2021-03-04 |