| NPI | 1518392182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: HI DT-2565) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MO 2013021026) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2016-03-07 |