| NPI | 1063087641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12013664A) |
| Additional Taxonomies | 261QS1000X Clinic/Center Student Health |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-06-22 |