| NPI | 1992803571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 3727-13) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MS PER-505-16) |
| 1223P0700X Dentist, Prosthodontics (Licence: TN 8586) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MS PROS-504-16) | |
| 1223P0300X Dentist, Periodontics (Licence: TN 8586) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-06-29 |