| NPI | 1053753061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011992A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.029505) |
| 122300000X Dentist (Licence: IL 019.029505) | |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2019-05-01 |