| NPI | 1780083311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS OS-538-17) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ZZ 15341809-8) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2019-01-31 |