NPI | 1598741746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA 15944) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA 15944) |
Enumeration Date | 2005-12-20 |
Last Update Date | 2007-07-08 |