| NPI | 1083870687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 22273) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MA DN22273) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2016-12-27 |