| NPI | 1134553449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: PA DS026156-L) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 014690) |
| 1223P0300X Dentist Periodontics (Licence: NJ 22DI01643900) | |
| 1223P0300X Dentist Periodontics (Licence: NY 041690) | |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2024-11-25 |