| NPI | 1902587991 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014557A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.034577) |
| 1223G0001X Dentist, General Practice (Licence: FL 28477) | |
| 122300000X Dentist (Licence: FL 28477) | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-09-05 |