| NPI | 1508889387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS036012) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02300400) |
| 1223P0300X Dentist, Periodontics (Licence: DE G1-0001284) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-07-22 |