| NPI | 1750707832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PR 3230) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3230) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PR 3230) | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2021-11-03 |