| NPI | 1760601405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008293A) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7690) |
| 122300000X Dentist (Licence: NV 4062) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2016-09-29 |