| NPI | 1912226481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1855774) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 59221) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2023-03-14 |