| NPI | 1598053126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855892) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04936) |
| 122300000X Dentist (Licence: CT 010682) | |
| 122300000X Dentist (Licence: PA DS038961) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-01-17 |