| NPI | 1346751187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025140) |
| 1223G0001X Dentist, General Practice (Licence: TX 34378) | |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2023-03-22 |