| NPI | 1083160741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12012486A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012486A) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2025-09-14 |