| NPI | 1285791210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 3210-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 17881) |
| 122300000X Dentist (Licence: NY 34735) | |
| 122300000X Dentist (Licence: MA 14236) | |
| 1223P0300X Dentist, Periodontics (Licence: MS PER-351-01) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |