| NPI | 1497187140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 12396) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 7145-15) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 7145-15) | |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2024-01-10 |