| NPI | 1194109710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021666) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012829A) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2023-07-17 |