| NPI | 1215451216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA DN1858936) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858936) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1858936) | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2026-07-03 |