| NPI | 1538386057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 8300) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: GA DN013221) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2017-02-27 |