| NPI | 1699039792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901601571) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT 2474) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: HI DT-2474) | |
| 183500000X Pharmacist (Licence: HI PH 2612) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-08-02 |