| NPI | 1063016814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014866A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1860029) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2025-10-10 |