| NPI | 1790944106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8643) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12012104A) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 8643) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12012104A) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2015-03-31 |