| NPI | 1790213098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12012708A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012708A) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2020-01-17 |