| NPI | 1629799515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601633) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013931A) |
| 122300000X Dentist (Licence: CA 109998) | |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2025-02-08 |