| NPI | 1740499052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NH 03967) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 050446) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-01-22 |