| NPI | 1821227232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MD 14401) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MA 20633) |
| 1223P0300X Dentist Periodontics (Licence: NY 053939) | |
| 1223P0300X Dentist Periodontics (Licence: VA 0401412265) | |
| 1223P0300X Dentist Periodontics (Licence: DC DEN1000796) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2021-03-11 |