| NPI | 1699828640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: RI DEN01816) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 13148) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2007-07-08 |