| NPI | 1720772007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2952000830) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12013954A) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2023-08-30 |