| NPI | 1912576075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12014668A) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2026-04-13 |