| NPI | 1851794978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1856937) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02528600) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2023-03-14 |