| NPI | 1720286362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 12642) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401411831) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2024-10-09 |