| NPI | 1821293465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC 1000499) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MD 12518) |
| 1223P0300X Dentist, Periodontics (Licence: NY 47336) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-07-08 |