| NPI | 1679729750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011494A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019835) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2023-03-07 |