| NPI | 1285024109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 8335 SP-(PERIO) 838) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014734) |
| 122300000X Dentist (Licence: MI 2901020500) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2015-01-30 |