| NPI | 1457871329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013192A) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415498) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2021-03-10 |