| NPI | 1053048462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL15333) |
| Additional Taxonomies | 125Q00000X Oral Medicinist (Licence: MA DL15333) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2022-08-05 |