| NPI | 1447506100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 055386) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18331) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |