| NPI | 1386764298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1858538) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 059352) |
| 1223P0700X Dentist, Prosthodontics (Licence: MO 2017030527) | |
| 1223P0700X Dentist, Prosthodontics (Licence: PR 1860) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-01-28 |