| NPI | 1134108970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010406A) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID 12010406A) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-01-12 |