| NPI | 1376687509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12011411A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 7881) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2023-01-19 |