| NPI | 1043888118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 12640) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122309) |
| 1223G0001X Dentist, General Practice (Licence: TN 12640) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-12-19 |