| NPI | 1215465505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1857578) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857578) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-07-07 |