| NPI | 1063675494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1855348) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855348) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2010-08-11 |