| NPI | 1538316856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 8956) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 8956) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |