| NPI | 1649706300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601248) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012752A) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2022-06-10 |