| NPI | 1902935604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30013529) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12006618A) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-12-09 |