| NPI | 1891966404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS OS-427-10) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5441) |
| 122300000X Dentist (Licence: MS 3528-09) | |
| Enumeration Date | 2008-03-22 |
| Last Update Date | 2015-12-29 |