| NPI | 1891866893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 7175) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401419946) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2026-08-11 |