| NPI | 1144874470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013784A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032259) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2024-11-11 |