| NPI | 1508433822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: HI DT-3135) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026526) |
| Enumeration Date | 2021-06-06 |
| Last Update Date | 2024-01-09 |