| NPI | 1538860242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859976) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MA DN1859976) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MA DN1859976) | |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2026-06-14 |