| NPI | 1932177698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD0000012798) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000002979) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2018-08-22 |