| NPI | 1548356736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D 7738) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22D102267203) |
| 1223P0300X Dentist, Periodontics (Licence: NY 050252) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-06-02 |