| NPI | 1356718175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012857A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030326) |
| 1223G0001X Dentist, General Practice (Licence: IN 12012857A) | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2018-05-15 |