| NPI | 1285263012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 10520) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417153) |
| 122300000X Dentist (Licence: IN 12013758A) | |
| 122300000X Dentist (Licence: OH 30.027201) | |
| 122300000X Dentist (Licence: TN 11405) | |
| 122300000X Dentist (Licence: CA 105652) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-04-01 |