| NPI | 1184763237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 14382) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14382) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-03-16 |