| NPI | 1396265187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9928) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10546) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-03-11 |