| NPI | 1780244293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11312) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 6574972-9922) |
| 1223G0001X Dentist, General Practice (Licence: TN 11312) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-05-14 |