| NPI | 1992202261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013413A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10968) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2020-06-24 |