| NPI | 1669147484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MA DN1859159) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859159) |
| 1223P0300X Dentist, Periodontics (Licence: NH 05112) | |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-10-21 |