| NPI | 1306093133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 10688) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2328) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2018-06-05 |