| NPI | 1639866213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5558) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 13346887-9923) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-06-23 |