| NPI | 1215369467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 15491) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: HI DT-3096) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2025-08-20 |