| NPI | 1912482704 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IN 12014333A) | 
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ZZ 68587) | 
| Enumeration Date | 2018-09-27 | 
| Last Update Date | 2024-05-21 |