| NPI | 1639520042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012673A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021969) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2021-03-24 |