| NPI | 1942433727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL10738) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 27579) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2012-03-28 |