| NPI | 1790381622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 111707) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 11918999-2903) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2025-10-08 |