| NPI | 1174906945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NH 04444) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA DN1856946) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2019-06-21 |