| NPI | 1538151691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: RI DEN03719) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN20111) |
| 1223G0001X Dentist, General Practice (Licence: MA DN20111) | |
| 1223G0001X Dentist, General Practice (Licence: CT 009215) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-08-02 |