| NPI | 1174076236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12013130A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019030729) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2021-01-29 |