| NPI | 1831466960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00202811) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6176) |
| 122300000X Dentist (Licence: TN 10147) | |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2016-08-12 |