| NPI | 1114156981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 8930) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401412308) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-07-14 |