| NPI | 1811954795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 7015) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: RI 2252) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2008-04-02 |