| NPI | 1457354441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009174) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019017190) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-11-26 |