| NPI | 1134653744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30025320) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012899A) |
| 122300000X Dentist (Licence: TX 32703) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2018-10-02 |