| NPI | 1437112380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011206) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 17583) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2017-04-27 |