| NPI | 1578731592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA DN1857489) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 153) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2025-03-13 |