| NPI | 1376332882 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 111354) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 12885) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-07-23 |