| NPI | 1407365703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA DN1857763) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857763) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2023-07-11 |