| NPI | 1982704847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12011706A) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 36731) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 5803) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-09-28 |