| NPI | 1396722617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 044825) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 15589) |
| 1223P0300X Dentist, Periodontics (Licence: VA 8493) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2007-07-08 |