| NPI | 1740571421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9268) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9268) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2023-10-16 |