| NPI | 1003296823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012319A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 21241) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2021-04-02 |