| NPI | 1255828356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11211) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416486) |
| 1223G0001X Dentist, General Practice (Licence: NC 13056) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-06-29 |