| NPI | 1649272121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12010542A) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IN 12010542A) |
| Enumeration Date | 2005-08-13 |
| Last Update Date | 2024-10-24 |