| NPI | 1811970254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12010004) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 7213) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12010004) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7213) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-11-21 |