| NPI | 1972172633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11789) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013658A) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2023-07-12 |