| NPI | 1972345809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12014467A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019035133) |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-03-22 |