| NPI | 1336680552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000010624) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4304) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-11-13 |