| NPI | 1154586162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 14431) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401412038) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2010-01-20 |