| NPI | 1154004976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014062A) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 13430) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-09 |