| NPI | 1629352661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA DN1856357) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055915) |
| 122300000X Dentist (Licence: CT 10783) | |
| 122300000X Dentist (Licence: CA 60820) | |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2016-12-14 |