| NPI | 1750580254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MS PROS-444-11) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3446-08) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-12-14 |