| NPI | 1710964127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS7022) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD00000030933) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-03-07 |