| NPI | 1508591082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03693) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859558) |
| 124Q00000X Dental Hygienist (Licence: MA DH90395) | |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-09-25 |