| NPI | 1093375321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ND 2553) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11077) |
| 126800000X Dental Assistant | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-04-03 |