| NPI | 1326559238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL13456) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102100) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |