| NPI | 1164133377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IN 12013590A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013590A) |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2024-01-30 |