| NPI | 1780991455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9147) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413647) |
| 122300000X Dentist (Licence: TN 6624) | |
| 122300000X Dentist (Licence: MD 17808) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2024-07-26 |