| NPI | 1508936162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 19042) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NH 3420) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2009-03-11 |