| NPI | 1487151114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11446) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10121) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2020-10-13 |