| NPI | 1548618622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 1890-80) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS PER-201-87) |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2016-05-30 |