| NPI | 1558848424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 112390) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10835) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2026-03-18 |