| NPI | 1588005045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS8703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000008703) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2025-06-09 |