| NPI | 1497530273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DL100347) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DL15811) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2024-08-16 |