| NPI | 1750868436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000010760) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000010760) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN DS0000010760) | |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2023-07-13 |