| NPI | 1063194413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12014955A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034544) |
| 1223G0001X Dentist, General Practice (Licence: IN 12014955B) | |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2026-03-31 |