| NPI | 1912616640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12041588A) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0134126) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2025-08-08 |