| NPI | 1467183509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04762) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859418) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2023-06-21 |