| NPI | 1750355194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12008878) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901012290) |
| 1223P0300X Dentist, Periodontics (Licence: NY 040718) | |
| 1223P0300X Dentist, Periodontics (Licence: PA DS020240L) | |
| 1223P0300X Dentist, Periodontics (Licence: NE 5321) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 019-020471) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-07-10 |