| NPI | 1891205084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 10672) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT-2712) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2026-05-01 |