| NPI | 1932497096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AR 4105) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2010016291) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2018-11-06 |