| NPI | 1326212630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN134001) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN13400201C) |
| 122300000X Dentist (Licence: MA DN13400501D) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |