| NPI | 1740823657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12013890A) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026615) |
| 122300000X Dentist (Licence: CA 104415) | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2022-08-01 |