| NPI | 1821717448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 12638) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO Den.00205337) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-01-31 |