| NPI | 1447638648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38774) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013111A) |
| 1223G0001X Dentist, General Practice (Licence: TX 38774) | |
| 1223P0700X Dentist, Prosthodontics (Licence: IN 98000707A) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 38774) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-01-23 |