| NPI | 1669013355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12349) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6714) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2024-11-18 |