| NPI | 1649641507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001669-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013705A) |
| 1223P0300X Dentist, Periodontics (Licence: IL 021.002719) | |
| 122300000X Dentist (Licence: IL 019.029769) | |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2026-02-10 |