| NPI | 1427195338 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 007947) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: RI DEN02527) |
| 1223P0300X Dentist, Periodontics (Licence: MA 17970) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |