NPI | 1033242979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 12314) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 12314) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA 12314) | |
Enumeration Date | 2007-03-13 |
Last Update Date | 2007-07-09 |