| NPI | 1013222389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MD 11128) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: PA 029607) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2017-06-13 |