| NPI | 1013207265 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011879A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.023620) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2016-07-13 |