| NPI | 1417172610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN28930) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 050215) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-08-12 |