NPI | 1336160472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN20864) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 20864) |
Enumeration Date | 2006-07-22 |
Last Update Date | 2023-11-20 |