| NPI | 1932256823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN Medical: 46360) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 9139) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN Dental: 9139) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-01-11 |