| 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 |