| NPI | 1851562466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 5916) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 063867) |
| Enumeration Date | 2008-03-23 |
| Last Update Date | 2025-02-03 |