| NPI | 1902829229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: KY 5446) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 8270) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2010-08-03 |