| NPI | 1861727646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 2393Dental) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6202-15) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 2393) | |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2018-03-01 |