| NPI | 1053477281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 19607) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NH 2083) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2008-05-21 |