| NPI | 1306239603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 11529) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: LA 6566) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: TN 11529) | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2023-03-20 |