| NPI | 1639650187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013338A) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001921-15) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-08-19 |