| NPI | 1811670011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 12660) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 12660) |
| 122300000X Dentist (Licence: TN 12660) | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2025-12-23 |