| NPI | 1598376808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 13058) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.10447.GD) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2026-05-07 |