| NPI | 1649602681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1857875) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02544200) |
| 1223G0001X Dentist, General Practice (Licence: PA DS039702) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 12160) | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2018-04-26 |