| NPI | 1437152386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 7851) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA 11918) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-07-08 |