| NPI | 1962079640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014516A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9900) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2024-08-13 |