| NPI | 1568993525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9919) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2020-11-17 |