| NPI | 1124410741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02877900) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 16795) |
| 1223P0300X Dentist, Periodontics (Licence: PA DS041521) | |
| 1223P0300X Dentist, Periodontics (Licence: DC DEN1002200) | |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2022-01-11 |