| NPI | 1245441526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AR 16) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3543) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-04-20 |