| NPI | 1174738009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 048278) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS031586L) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-01-04 |