| NPI | 1235932997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL100403) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA DL100403) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |