| NPI | 1033593751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NH 04673) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12637) |
| 1223E0200X Dentist, Endodontics (Licence: ME DEN4841) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2021-09-24 |