| NPI | 1619383437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: MA DL15241) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MA DL12955) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-06-23 |