| NPI | 1871801795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS 3722-13) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3722-13) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2018-07-16 |