NPI | 1699981670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN21290) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21290) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NJ 22DI02713100) | |
Enumeration Date | 2007-05-15 |
Last Update Date | 2021-04-27 |