| NPI | 1730672700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013081A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10143) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-07-18 |