| NPI | 1881124261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11799) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33143) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2025-09-15 |