| NPI | 1932198694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN DS0000008111) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TN MD0000037255) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2013-03-22 |