| NPI | 1619202777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1855561) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036130) |
| 122300000X Dentist (Licence: NY 048569) | |
| 122300000X Dentist (Licence: IN 12010955A) | |
| 122300000X Dentist (Licence: NJ 22DI02321900) | |
| 122300000X Dentist (Licence: OH 30.021372) | |
| 122300000X Dentist (Licence: RI DEN03250) | |
| 122300000X Dentist (Licence: CT 10170) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2026-05-19 |