| NPI | 1952754749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014346A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9824) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2024-04-10 |