NPI | 1639518921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN 1856331) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DL11569) |
Enumeration Date | 2013-06-19 |
Last Update Date | 2023-03-30 |