| NPI | 1528753688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 12783) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401419359) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-06-04 |