| NPI | 1376126870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 11562) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11562) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2023-06-02 |