| NPI | 1508559790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014111A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034207) |
| 122300000X Dentist (Licence: UT 13550097-9922) | |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-11-09 |