| NPI | 1376244905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12473) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859986) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2025-12-12 |