| NPI | 1376821181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AR 3958(DDS); 37(Perio)) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27107) |
| 1223P0300X Dentist, Periodontics (Licence: AR 3958) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2019-03-18 |