| NPI | 1720338296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IA 10159) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 98000607A) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2023-10-25 |