| NPI | 1811147598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA 12356) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CT 006125) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2008-09-30 |