| NPI | 1790046043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011854A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029108) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2018-01-31 |