| 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 |