| NPI | 1144776923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA DN1858721) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16006) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2021-12-05 |