NPI | 1174905343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013116A) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021614) |
Enumeration Date | 2015-06-24 |
Last Update Date | 2021-03-18 |