| NPI | 1306940994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 009411) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 20271) |
| 1223P0300X Dentist, Periodontics (Licence: NY 0518851) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |