| NPI | 1477392439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29442) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 12618) |
| 122300000X Dentist (Licence: GA DN123604) | |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2025-11-14 |