| NPI | 1770006462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN LDR210275) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8995) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2021-07-23 |