| NPI | 1619351772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012395A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600238) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2024-04-16 |