| NPI | 1578123360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013214A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032070) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2019-06-20 |