| NPI | 1063541936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 045422-1) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 19260) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2017-10-03 |