| NPI | 1184465478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 112351) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 13060) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2026-07-17 |