| NPI | 1174214753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 12768) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 12768) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2025-08-12 |