| NPI | 1427433119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: AK 180497) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10095) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2021-10-08 |