| NPI | 1710413745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901602642) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: AR 4441) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-07-14 |