| NPI | 1104460260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014317A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021021829) |
| 122300000X Dentist (Licence: KS 62031) | |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2024-02-09 |