| NPI | 1295353696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 418021) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11344) |
| Enumeration Date | 2020-07-12 |
| Last Update Date | 2025-09-10 |