| NPI | 1194946798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TN 10747) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10747) |
| 1223P0700X Dentist, Prosthodontics (Licence: NJ NJDIO18946) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-06-01 |