| NPI | 1104082437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021075) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011682A) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2015-03-01 |