| NPI | 1083269096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11152) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 11152) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2025-03-20 |