| NPI | 1427367820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 010130) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 0551681) |
| Enumeration Date | 2010-10-02 |
| Last Update Date | 2010-10-02 |