| NPI | 1437729365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS043312) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02724600) |
| 1223P0300X Dentist, Periodontics (Licence: NY 063021) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-08-30 |