| NPI | 1770716607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IN 12011064A) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 052940) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2016-11-15 |