| NPI | 1407991896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 11459 MA) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 11459) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |