| NPI | 1366963530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN10000289) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022182) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-07-24 |