| NPI | 1578963740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA Dn1856722) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856722) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2017-09-14 |