| NPI | 1508950924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: RI DNT2262) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: RI DNT 2262) |
| 1223P0300X Dentist, Periodontics (Licence: MA DN16220-1) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-12-13 |