| NPI | 1356900419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014092A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10419) |
| 122300000X Dentist (Licence: IL 019.032156) | |
| 1223P0300X Dentist Periodontics (Licence: IL 021003300) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2024-07-29 |