| NPI | 1003533407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MA DL15452) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02978800) |
| 1223G0001X Dentist General Practice (Licence: PA DS044316) | |
| 1223G0001X Dentist General Practice (Licence: MD 18281) | |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2023-11-02 |