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 |