| NPI | 1063724805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012081A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028411) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2016-05-17 |