| NPI | 1871658070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN Dentistry12009698) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN Medicine01039528) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-08-08 |