| NPI | 1235827775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014384A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 1235827775) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2024-05-28 |