| NPI | 1316527328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859719) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL14784) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2023-05-13 |