| NPI | 1669031845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013491A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11311862) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-01-19 |