| NPI | 1013931229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 4036) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 8228) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2010-08-03 |