| NPI | 1912089871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN 21127) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 5424) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2018-05-04 |