| NPI | 1376942383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013315A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856701) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2020-04-16 |