| NPI | 1063023554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11367) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4454) |
| Enumeration Date | 2020-08-10 |
| Last Update Date | 2020-08-10 |