| NPI | 1013280676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 12468) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 58799) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2025-07-14 |