| NPI | 1023314333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413303) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037297) |
| 1223P0300X Dentist, Periodontics (Licence: VA 0401413301) | |
| 1223P0300X Dentist, Periodontics (Licence: MD 14934) | |
| 1223P0300X Dentist, Periodontics (Licence: PA DS037297) | |
| 122300000X Dentist (Licence: MD 14934) | |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2013-06-19 |