| NPI | 1568948552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12014022A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022760) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025719) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-03-04 |