| NPI | 1033605597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 10864) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022699) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-09-25 |