| NPI | 1194176263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12012998A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN LDR160160) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2018-07-25 |