| NPI | 1053154823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014463A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 12014463A) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2026-03-08 |