| NPI | 1659938108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12014170A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600454) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2023-08-08 |