| NPI | 1790520211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 30741) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 12554) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2025-08-06 |