| NPI | 1669210407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.035303) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12014528A) |
| Enumeration Date | 2024-07-16 |
| Last Update Date | 2024-07-16 |