| NPI | 1174214753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 12768) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 11354) |
| 122300000X Dentist (Licence: TN 12768) | |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2026-04-15 |