| NPI | 1952534893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL 10747) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 33424) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2018-03-17 |