| NPI | 1609560606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IN 12014094A) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30.027225) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-08-23 |