| NPI | 1356077093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013943A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033941) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2022-10-17 |