| NPI | 1144756792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025978) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012674A) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2021-04-20 |