| NPI | 1215506613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 0006889) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-08-10 |