| NPI | 1811300270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012582A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.030130) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2016-08-31 |