| NPI | 1194265652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013070A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019031098) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025514) | |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2019-09-11 |