| NPI | 1134314941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN 9830) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011058A) |
| 1223G0001X Dentist, General Practice (Licence: OH 30-022631) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2016-03-15 |