| NPI | 1720333677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011914A) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057659-1) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2024-01-19 |