| NPI | 1629242946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC DEN1000707) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 13704) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |