| NPI | 1639504558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856593) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 15916) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2026-09-17 |