| NPI | 1124076328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN20536) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 20536) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-03-04 |