| NPI | 1033883533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS12100) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 179650) |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2025-02-17 |