NPI | 1700300498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: TN 10826) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2017027434) |
Enumeration Date | 2017-08-03 |
Last Update Date | 2022-03-15 |