| NPI | 1750874210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013955A) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10759) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2022-11-30 |