| NPI | 1639367634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicine (Licence: MA DN21940) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21940) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2026-02-25 |