| NPI | 1013131895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: MA 12656) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MA 12656) |
| 1223P0300X Dentist Periodontics (Licence: MA 12656) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA 12656) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MA 12656) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |