| NPI | 1033473194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857924) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MA DF11134) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2024-04-27 |