NPI | 1700094158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN21905) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 21905) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-05-18 |
Last Update Date | 2018-06-08 |