| NPI | 1982220497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT-3140) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600517) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2025-03-25 |