| NPI | 1568804961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2022006316) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10313) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 61841) | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2022-07-29 |