| NPI | 1598544025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12676) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 109092) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2025-01-15 |