| NPI | 1700404092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IN 12013381A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 12013381A) |
| 122300000X Dentist (Licence: IN 12013381A) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2025-04-28 |