| NPI | 1356538656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AR 34) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3613) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2016-02-25 |