| NPI | 1588032395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: MA DN1857061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1857061) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1857061) | |
| 1223X2210X Dentist, Orofacial Pain (Licence: MA DN1857061) | |
| 208D00000X General Practice (Licence: MA DN1857061) | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2021-10-14 |