| NPI | 1013171156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011545A) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI WI6335) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401412148) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2024-05-03 |