| NPI | 1306002787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA DDS-10393) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9572) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2025-09-05 |