| NPI | 1942216023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DTP735) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 037011) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-02-01 |