| NPI | 1124757976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 14018806-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT-3004-0) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2024-11-18 |