| NPI | 1629557012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1859764) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 10858402-8903) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11022) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 10858402-9925) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-06-20 |