| NPI | 1992064349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 15418) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 15418) |
| 122300000X Dentist (Licence: KY 9227) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9227) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT 66167) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2020-12-08 |