| NPI | 1851353601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12009491) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7966) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2020-08-17 |