| NPI | 1760778542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 9310) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9310) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 5956 C1) | |
| 122300000X Dentist (Licence: AL 5956 C1) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2014-07-02 |