| NPI | 1407945173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009324) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 122300000x) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2009-01-27 |