| NPI | 1922356997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: SC 8489) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IN 12011462A) |
| Enumeration Date | 2012-08-24 |
| Last Update Date | 2020-10-22 |