| NPI | 1548598576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D010274) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 053823) |
| 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02429400) | |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2023-08-03 |