| NPI | 1821291634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TN 8544) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 8544) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2009-09-21 |