| NPI | 1568986487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11537) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33154) |
| 122300000X Dentist (Licence: UT 13342387-9921) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2023-05-16 |