| NPI | 1265766315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 059613) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL11820) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DL11820) | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2023-03-07 |