| NPI | 1104277516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012548A) |
| Additional Taxonomies | 126900000X Dental Laboratory Technician (Licence: IN 12012548A) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2020-11-25 |