| NPI | 1679203764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN29528) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12014253A) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-09-24 |