| NPI | 1003029679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NH 05001) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 13692) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-03-12 |