| NPI | 1821008442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 6718) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NC 8653) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2009-09-25 |