| NPI | 1275909467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 01644) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DF60582867) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2026-05-06 |