| NPI | 1114542602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 12068) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4644) |
| 122300000X Dentist (Licence: LA 7056) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-03-24 |