| NPI | 1730798745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11513) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS042857) |
| Enumeration Date | 2020-07-26 |
| Last Update Date | 2023-08-04 |