| NPI | 1578683892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011727A) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50052656) |
| 1223G0001X Dentist, General Practice (Licence: IL 019028218) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-01-21 |