| NPI | 1609365675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 12438) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102404) |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2024-08-29 |