| NPI | 1417565193 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11423) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 204657) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2024-10-03 |