| NPI | 1174511364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04473) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858447) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-09-05 |