| NPI | 1033483359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 10219) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9239) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2018-05-15 |