| NPI | 1700525276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4645) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 11899) |
| 1223G0001X Dentist, General Practice (Licence: TN 11899) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2024-03-18 |