| NPI | 1790003796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 73880) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5862) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12012427A) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2022-02-07 |