| NPI | 1245839703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859165) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1859165) |
| 1223G0001X Dentist, General Practice (Licence: CA dds104365) | |
| Enumeration Date | 2020-10-25 |
| Last Update Date | 2022-01-25 |