| NPI | 1255077582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859345) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1859345) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-18 |