| NPI | 1598741746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MA 15944) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 15944) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-09-11 |