| NPI | 1770251043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12595) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37825) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2026-09-01 |