| NPI | 1932157500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MS OS41108) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17892) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 17730 3477-08,05411-) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-07-05 |