| NPI | 1487338463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014868A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.034891) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: KY 10993) | |
| 1223G0001X Dentist, General Practice (Licence: MO 2025017068) | |
| 1223G0001X Dentist, General Practice (Licence: TN 12645) | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-09-23 |