| NPI | 1801924659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: HI MD-10737) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: HI DT-1815) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2021-01-19 |