| NPI | 1437871043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859588) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859588) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-08-28 |