| NPI | 1649425596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MS 23598) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN014405) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS036967) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 3785-15) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2024-05-01 |