| NPI | 1194462549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12123) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10758) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2023-02-28 |