| NPI | 1114304524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TN 9930) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9930) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2025-04-07 |