| NPI | 1104371160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11156) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DB-2026-0315) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2026-08-12 |