| NPI | 1972671238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 3828) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 024922-1) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2012-05-09 |