| NPI | 1093184616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NH 04464) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS040366) |
| 1223P0300X Dentist, Periodontics (Licence: MA DN1859326) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2024-09-24 |