| NPI | 1548248859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 8759) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 8698) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2011-06-08 |