| NPI | 1528598299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1857626) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857626) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857626) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2017-06-15 |