| NPI | 1710218490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 12957) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7491917-9926) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2026-02-17 |