| NPI | 1275941288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D-4831-PE) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX ETN283) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-04-05 |