| NPI | 1831394352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 010754) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053348-1) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2013-01-24 |