| NPI | 1598998528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN19560) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DN1855656) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2019-06-19 |