| NPI | 1134899446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013703A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10695) |
| 122300000X Dentist (Licence: VA 0401417584) | |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2023-06-01 |