| NPI | 1942399159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: IN 12012587A) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OH 30-022164) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 63091) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-10-09 |