| NPI | 1245949262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 12827) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA N127582) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2025-09-16 |