| NPI | 1053327825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CT 03419) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CT 003419) |
| 1223P0300X Dentist Periodontics (Licence: MA DN9324120384SERIAL) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-08-10 |