| NPI | 1487338463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2025017068) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10993) |
| 1223G0001X Dentist General Practice (Licence: TN 12645) | |
| 1223G0001X Dentist General Practice (Licence: IL 019.034891) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-07-08 |