| NPI | 1104207299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN23717) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DN1858014) |
| 1223P0300X Dentist, Periodontics (Licence: NH 04820) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 34457) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2024-08-27 |