| NPI | 1538285341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 13291) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 19236) |
| 1223P0700X Dentist, Prosthodontics (Licence: MA 21076) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |