| NPI | 1518659309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12763) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7745) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2025-12-12 |