| NPI | 1780131334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012805A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857393) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.031446) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-03-08 |