NPI | 1689129942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02604700) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 059538-01) |
1223P0300X Dentist, Periodontics (Licence: MA DN18575614) | |
Enumeration Date | 2016-08-16 |
Last Update Date | 2020-09-17 |