| 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 |