| NPI | 1922100379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NH 6297) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 01684) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2017-03-01 |